This was just submitted to CSM 2014 Women's Health for a paper presentation.
Pelvic joint mobilization for false positive late pregnancy
instability
A 29 year old female in the 32nd week of pregnancy had progressive
pelvic pain and perceived instability feeling that her pelvis was coming apart
in the front. She maintained hip adduction with all positional changes. Gait was
antalgic, with a narrow base of support and shortened stride length. Pelvic
instability in pregnancy is a well-established concept due to the enhancing size
of the fetus, with a background of hormonal priming; particularly relaxin and
estrogen. Evaluation was performed in a very cautious and limited manner with
the expectation that significant pelvic instability would be encountered.
Instead, micromotion testing revealed a surprising, significant hypomobility in
multiple directions. Within a single intervention her posture and mobility were
much improved, along with significant pain reduction. She reported significant
improvement in bladder control and went on to have an easy natural delivery. In
this case the subjective sense of instability was most likely a reflection of
the visceral and neural tension and compression in response to the
3-dimensional non-physiological positioning of the pelvic articulations with
induced spasm. This case of true hypomobility presenting as subjective
“instability” underscores the utility of joint micromotion testing, AKA
springing with awareness. Hypomobility and hypermobility are relevant peripartum
constructs.
Pelvic joint mobilization for false positive late pregnancy
instability
A 29 year old female in the 32nd week of pregnancy had progressive
pelvic pain and perceived instability feeling that her pelvis was coming apart
in the front. She maintained hip adduction with all positional changes. Gait was
antalgic, with a narrow base of support and shortened stride length. Pelvic
instability in pregnancy is a well-established concept due to the enhancing size
of the fetus, with a background of hormonal priming; particularly relaxin and
estrogen. Evaluation was performed in a very cautious and limited manner with
the expectation that significant pelvic instability would be encountered.
Instead, micromotion testing revealed a surprising, significant hypomobility in
multiple directions. Within a single intervention her posture and mobility were
much improved, along with significant pain reduction. She reported significant
improvement in bladder control and went on to have an easy natural delivery. In
this case the subjective sense of instability was most likely a reflection of
the visceral and neural tension and compression in response to the
3-dimensional non-physiological positioning of the pelvic articulations with
induced spasm. This case of true hypomobility presenting as subjective
“instability” underscores the utility of joint micromotion testing, AKA
springing with awareness. Hypomobility and hypermobility are relevant peripartum
constructs.
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